To this point we have attempted to summarize what we believe to be the most exciting new findings relative to
sarcoidosis, along with providing data in support of those comments. We wish to conclude this brief review by sharing some anecdotal thoughts (no benefit of controlled clinical trials) concerning how the individual practitioner may apply this "research" information in caring for patients. In newly diagnosed patients with
sarcoidosis, especially with widespread use of transbronchial lung biopsy, we would recommend BAL at that time because it can provide very valuable information with minimal increased morbidity or cost. BAL, in combination with SACE and possibly
gallium scan (not required in all), along with the usual measures such as pulmonary function studies, chest roentgenograms (all of which are already commonly done) permit the clinician to make an accurate conclusion about disease activity in the lungs. Because there are no published therapeutic trials of
corticosteroids in which the ultimate prognosis of
pulmonary sarcoidosis has been improved, the decision to initiate
therapy in these patients remains a clinical one and is commonly based upon practitioner experience rather than a particular laboratory test per se. Once that decision has been made, a decision to repeat any "research" studies would have to be individualized. Clearly serial SACE measures are relatively inexpensive and without morbidity. Moreover, despite their lack of "diagnostic value" serial measurements in known
sarcoidosis have been shown to be very valuable in assessing disease activity and may therefore provide the clinician with a valuable aid to monitoring
steroid treatment. A less common and much more perplexing circumstance occurs when evaluating patients with
sarcoidosis established for several years present with evidence of progressive or chronic pulmonary involvement and
dyspnea. In such individuals a measure of activity would be very helpful because the clinician would like to avoid
steroids in persons with end stage and irreversible
fibrosis and consider their use in those individuals in whom there is evidence of continued disease activity. In this instance,
gallium scan, SACE and even BAL may all prove valuable. When we have found SACE elevated and
gallium scan positive, we have assumed the disease to be active (even if the chest X-rays show stability).(ABSTRACT TRUNCATED AT 400 WORDS)